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loll <br />' WATER SUPPLY WELL LOCATION SURVEY FORM <br /> POZO DE AGUA POSICION/ FORMA DE ENTREVISTA <br /> iSECOR International <br /> 3475 West Shaw Ave, Suite 104 <br />' Fresno, California <br /> (559) 271-2650 <br /> October/Octubre 2004 <br /> Well Survey Site Address/PozoGde Sibo de Entrrcvista <br /> Street/Calle <br />' City/Cuidad AoArm-po, C <br /> State/Estado, Zip Code/C6digo Postal52 <br /> e x No <br /> A water well is present on the property9/Un pozo de agua esti presente sobre la <br /> l <br /> caracteristica(propiedad)? <br /> Domesthc/Drinkmg water well/Pozo de agua Dom6stico/potable <br />' Agricultural/Landscape water well./Pozo de Agua agricola/paisale <br /> Unknown/Desconocido <br /> IT <br /> Ye 1 No <br />' Is the well being used?/LPozo el es usado? <br />' If own,please provide well construction details/Si conocido,por favor sum istre pozo detalles de <br /> construccibn <br /> Date mstalled/Fecha mstalada <br /> Depth of well/Profundidad de Pozo <br /> Casing Type/Tipo de Cubierta <br />' Casmg diameter/Diimetro de cubierta <br /> Screen mtervaVlntervalo de pantalla <br /> Survey completed by/RevisiGn winpletada por- <br /> Name/Nombre S hanie Furgal of SECOR for homeowner/busmess owner <br /> Signature/Fuma <br /> Date/Fecha f 6 <br />